Reimbursement

By Lydia Corum RN MSN CWCN

The times are changing in the world of wound care. There used to be a time when there were no problems with reimbursements, as long as the doctor wrote the order. Today, the Centers for Medicare & Medicaid Services (CMS) regulations confuse clinicians and make the world of healing wounds much more difficult. The changes are in the area of denials with not enough information given for choosing dressings, use of negative pressure therapy and hyperbaric oxygen therapy. Are all these changes needed? Why are these changes happening? What can hospitals and wound clinics do to make things better?

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders Alliance of Wound Care Stakeholders (Alliance) played a key role in educating the Food and Drug Administration (FDA) and its advisory panel on the role and real-world value of antimicrobial wound care dressings, as the FDA considered a regulatory classification of these products that could impact access and availability to wound care providers and patients.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders' (Alliance) quarterly update provides an overview of ongoing advocacy initiatives to ensure access, coverage and payment to wound care procedures and technologies for patients. This update includes current action items, updates on key areas of focus from the past quarter, and future issues for the second half of 2016 that the Alliance is tracking that are of importance to the wound care community, including clinicians who may be impacted by policy changes.

By Mary Ellen Posthauer RDN, CD, LD, FAND

The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) amends Title XVIII of the Social Security Act by adding a new section –Standardized Post-Acute Care (PAC) Assessment Data for Quality, Payment, and Discharge Planning. The goal of the IMPACT Act is to reform PAC payments and reimbursement while ensuring continued beneficiary access to the most appropriate setting of care. The act requires the submission of standardized and interoperable PAC assessment and quality measurement data by Long-Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Home Health Agencies (HHA) and Inpatient Rehabilitation Facilities (IRF).

By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWS, CWCN, CFCN

Ordering wound care dressing supplies can prove to be a frustrating task for many providers and clinicians. Unfortunately, I have encountered many health care providers that describe feelings of dread when working with their durable medical equipment (DME) counterparts.

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

Lawrence Mills introduced the concept of Value Analysis to the manufacturing industry a half century ago. The basic idea entails analyzing the function and importance of the various parts of a product as they relate to cost. He derived the following equation²:

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders submitted two sets of formal written comments to the Centers for Medicare and Medicaid Services (CMS) during September 2015 in response to the proposed updates to CMS' outpatient payment rates and to the physician payment schedule. The Alliance's comments focused on provisions that have potential impact to wound care. These proposed rules have important implications to health care providers and health care administrators as CMS sets future reimbursement for services and procedures.

By the WoundSource Editors

With approximately 68,000 codes (nearly five times the number of codes as ICD-9), the ICD-10 system can seem daunting. In addition to an expansion in the number of codes, with flexibility for new code development, ICD-10 codes themselves are also longer in length using 3 to 7 digits versus 3 to 5 digits.

By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWS, CWCN, CFCN

In the last installment of my blog, we discussed a brief overview of billing for wound care products and dressings (durable medical equipment or DME) in several common care settings. Let's talk about the Hospital Outpatient Department (HOPD) a little more in-depth. Again, we will use Medicare as the standard for payment policy, as many payors use them as a model for policy-making.